This website in a nutshell gives you info on your surgery. Designed for health consumers of the general public, is intended to provide an overview of common surgeries from head to toe. For each procedure, these short articles will provide you with information regarding the underlying disease process, the anatomy of the operative area, the usual preoperative preparation, the specifics of the procedure, and what to expect post-operatively. This site also features acustomized search engineof sites dealing with surgical topics written and edited by physicians, so if the information you seek is not on this site, we can still get it to you.

Recovering from surgery isn’t easy. It may take quite a bit of time before you start to feel like your usual self again. Thankfully, you can speed up the recovery process by taking vitamins. Make sure you give the supplements below a try:

Fish Oil

Fish oil is one of the most beneficial supplements that you can take. Two extremely potent fatty acids are found in fish oil: DHA and EPA. Both of these acids can improve communication between the cells in your body. This can make it easier for your body to recover from surgery.

Of course, this isn’t the only perk that fish oil can offer you. Fish oil can also improve your body’s hormone balance. Fish oil can strengthen your cognitive function and give your body more energy. Doctors and nutritionists frequently recommend this supplement.

Vitamin D

When you’re recovering from surgery, you may not have many opportunities to spend time under the sun. A lack of vitamin D can be extremely harmful to your body. Low vitamin D can lead to cognitive decline and a weakened immune system, and it can increase your risk of developing heart disease.

A vitamin D supplement can keep your immune system healthy. It can also help you to regain your muscle strength. Vitamin D can also help you to keep your spirits up as you recover. Studies have shown that taking Vitamin D can reduce your risk of developing depression.

Many of your body’s processes are directly affected by magnesium. In fact, researchers have found that magnesium can impact more than 300 operations. If you are deficient in magnesium, it will be difficult for you to recuperate from something like surgery.

Taking magnesium will also allow you to get the sleep you need as you recover. Magnesium can calm your nervous system, which can help you to relax as you go to bed at night. If your body isn’t getting enough magnesium, your blood pressure will spike, and your stress levels will rise. A supplement will give you all the magnesium that you need.

Multivitamins

In addition to taking the specific supplements listed above, you may want to think about taking a daily multivitamin. A multivitamin will help you to correct any deficiencies that your body might have.

Multivitamins provide your body with a wide range of essential nutrients. If you’re not getting enough zinc, or if you need a little bit more vitamin C, you’ll be able to get that from your multivitamin. When you take a top quality multivitamin, you can be sure that your body isn’t lacking in anything. You’ll have everything you need for a swift recovery. For older women you want to make sure you are getting the best type of vitamins. We recommend these as the best multivitamins for women over 50.

Surgery can take a severe toll on your body. That’s why you need to make sure you provide your body with all of the nutrients it needs as you recuperate. If you take advantage of these vitamins and supplements, you’ll be able to return to your regular schedule in no time at all.

PTA Programs

Currently, you will find over two hundred physical therapy assistant programs from the U.S. to eventually be a physical therapy assistant (PTA), a two-year Associate Degree is required. Educational classes need to be taken in an accredited college.

This is a college that has been accepted by the Commission on Accreditation in Physical Therapy Education. This certification makes sure that every one of the teachers and classes are of the maximum standard.

The American Physical Therapy Association doesn’t allow certification for physical therapy assistant programs which are only offered on the internet. This is a result of the requirement for clinic labs and real clinical experience.

The institution does accredit some PTA colleges that provide just a part of the schedule online when they need students to have actual clinical encounters, in addition to practice labs which are conducted in person.

Immediately Physical Therapy Assistant Programs

Some schools provide PTA degrees which have hastened choices and these are made so students may finish their class work faster. Some PTA apps can really be completed fourteen days rather than just two years of most conventional programs.

All these programs normally have online classes, with students engaging in trainee labs twice each session, usually at a 3 day weekend format.

The Greatest Physical Therapy Assistant Schools

The top PTA Tritonpt colleges are normally found in massive cities. Several have an internship arrangement with an local hospital or physical rehab center. Students that are enrolled at those schools typically work under the advice of physical therapists whenever they learn important individual management abilities.

What To Consider when Deciding on a PTA School

There are four primary aspects to take under account when choosing a college and they’re the admissions requirements, hands-on instruction, equipment and school. Many PTA levels are provided by four-year colleges and community colleges.

Admission Requirements

To be qualified for entry to the majority of physical therapy assistant colleges, certain high school classes in mathematics are required. It’s also important to get a good grade point average, particularly in different science classes including chemistry and mathematics. Candidates must also possess some volunteer experience in a healthcare field like an aide to your physical therapist. Letters of recommendation are obviously a benefit when applying to a PTA program.

Hands-On Coaching

Try to find schools which provide their students with a substantial amount of direct practical expertise. This may include work placement programs. The chance to work with customers and also to socialize with individuals of different ages is quite important to be successful in this healthcare area.

Equipment

The best PTA colleges will have a vast choice of equipment that’s readily available for their students to use. This contains testing and diagnostic programs, applications programs, in addition to patient management applications. Make sure to learn what the typical class size is to be sure that all students are going to have sufficient time to utilize the equipment. Simulation equipment, like mannequins is also quite useful, but they aren’t always accessible in all PTA schools.

Faculty

The majority of these colleges will have biographies of the teachers on their site. This information is crucial to read to learn more about the credentials of the physical therapy assistant college’s school. It will include information regarding the teacher’s academic credentials, special training, work experience, and some other honors they could have received.

Many people are interested in learning how to get rid of fibroids as quickly as possible. Whether they are suffering from symptoms associated with fibroids or are simply asymptomatic, many people are still curious to know what options exist to get rid of fibroid tumors.
In this article we offer an overview of the treatment options available today for women suffering with fibroids.

What are Fibroids?
First of all, what exactly are fibroid tumors? According to medical literature, fibroids are benign tumors that happen to grow from the smooth muscle layer of your uterus. They have also been referred to as myomas, leiomyomas, and uterine fibroids. Fibroids are just masses of uterine smooth muscle proliferation, and they can vary greatly in size. The reality is that 20% of women are affected by these fibroids during their lifespan. Researchers don’t have enough information about the exact origin of fibroids. However, studies indicate that estrogen plays a significant role in the development and growth of fibroid tumors. Therefore, it makes intuitive sense that reducing the estrogen level in your body will help you to get rid of fibroids.

Some people with fibroids may feel no symptoms at all, while others may suffer from such symptoms as anemia, constipation, and backache, among others.

Fibroids can cause excessive bleeding during your menstruation, and can grow rapidly when there is a hormonal imbalance within the body. If fibroids grow very large, they can cause such problems as infertility and iron-deficiency anemia. When women reach menopause, fibroid tumors tend to regress in size due to the decrease in estrogen level within the body. While many fibroid tumors pose no health risks to women, others may require treatment to prevent complications.

Treatment Options:
There are many medications out there designed to treat the symptoms associated with uterine fibroids. OCPs are one such medication that targets hormones which regulate the menstrual cycle. There are also many non-invasive treatment options that just preserve your uterus, and they do not require any sort of incisions. There are also many minimally invasive procedures out there, and they simply destroy your uterine fibroids without ever requiring major surgery. The mainstream surgical procedures that are available to treat fibroids include hysterectomy and abdominal myomectomy. Hysterectomy removes the uterus, thereby getting rid of the fibroids. However, women who undergo this procedure lose the ability to bear children. Myomectomy simply removes individual fibroid tumors while keeping the uterus intact. However, there is a high recurrence rate linked to myomectomy.

Natural Therapy to Get Rid of Fibroids:
While surgical options seem appealing to some, more and more people are being lured towards natural therapy to shrink their fibroids naturally.

The Beat Fibroids Channel on YouTube has shared many tips in their videos on how to get rid of fibroids naturally. Through dietary and lifestyle modifications, it is possible to reduce the symptoms associated with fibroids, as well reduce the size of fibroid tumors.

The focus should be on eliminating foods that are estrogenic and replacing them with foods that are anti-inflammatory. Estrogenic foods will aggravate fibroids and cause them to grow larger in size. You should also avoid foods that are laden with pesticides & herbicides and focus on consuming natural non-GMO foods.

Now that you know more about fibroids, you just have to take action. You can treat fibroids in many ways including medications. There are also many traditional procedures that will allow you to get rid of fibroids. You can also find natural ways of getting rid of fibroids through a simple search online. Be sure to talk to your doctor about your options and stay informed regarding the risks and benefits of each one.

With virtually any type of orthopedic surgical procedure there will be swelling at the site of the surgery. It doesn’t matter if you are having the procedure done on your knee, neck, elbow, you name it! There will be swelling of the surrounding muscles and skin.

In order to treat this swelling you must use ice for 20 minutes on and 20 minutes off. It’s just common sense. Here are some more important reasons that you should always cool the surgery site in recovery.

Customized Ice Packs Reduce Swelling

Obviously icing the site of the surgery will reduce the swelling. But how can you comfortably get this done without having to constantly hold a bag of peas on the area? Use a customized ice pack specifically designed to treat the problem area. There are a lot of products on the market that will treat all areas of your body. Click here to do a quick search for the best solution for your effected area.

Icing reduces tightness

Icing won’t only reduce the swelling, it will also reduce tightness in your muscles and shorten your recovery time. Just like how professional athletes sit in an ice bath to speed up recovery, you will be using ice to heal your knee, elbow, or wherever you had orthopedic surgery.

It will help with pain

Icing your wound will not only reduce the swelling and tightness, it will also numb the pain. If you have had orthopedic surgery recently then you know how painful the road to recovery can be. The hips, spine, and knees are especially painful because it’s a joint that you can’t really avoid using much of the time. Recovery can be quite painful and having the right ice pack for the job is essential.

Your surgeon told you to so listen!

Your surgeon certainly told you that you should be icing the site of the surgery. If you want this to be a more painful process than it should be then don’t listen. But if you want to speed up your recovery time, reduce tightness, and have far less pain without popping a t4 every 4 hours, then use a custom ice pack. You will only be sorry if you don’t.

Where can you get the best custom ice pack products?

If you are using a bag of frozen peas or corn you are wasting your time. You need something that will work during the long recovery process. Visit http://gelpax.com if you want to see all of the customized ice pack options for people in their recovery. Gelpax.com supplies to orthopedic clinics across North America so chances are if your doctor gives you a gel pack to use in your recovery, you are using one from gelpax.com.

Blepharoplasty is a medical procedure used to repair droopy eyelids by removing the excess skin, fat, and muscle that can build up with age. Patients undergoing blepharoplasty are typically awake during the procedure, although many are given medication to relieve anxiety and numbing injections to reduce pain around the eyes. It is extremely rare that a patient undergoing blepharoplasty requires an overnight stay in the hospital, as most doctors prefer to perform the procedure in their offices or an outpatient surgery center.

Eyelid surgery can also be used as a medical intervention for those suffering from diseases such as myasthenia gravis, which is when excessive upper eyelid skin is causing a loss of peripheral vision. Many insurance providers cover the procedure as a non-elective operation since eyelid surgery can be performed to restore vision.

It is essential that patients understand the boundaries of a blepharoplasty procedures. Although doctors can cut out loose skin and fat tissue and tighten eyelid muscles to give patients a refreshed appearance, they cannot remove wrinkles around the eyes, lift sagging eyebrows, or eliminate dark circles with a blepharoplasty procedure.

Are You A Candidate?

It is important that patients seeking eyelid surgery be in excellent physical health and have realistic expectations as to the results of the surgery. Factors that are commonly weighed when determining a patient’s candidacy for blepharoplasty include age, skin type and ethnic background, as well as the degree to which vision is obstructed for those who are looking into the procedure for medical purposes rather than cosmetic.

Patients suffering from circulatory or ophthalmological issues, heart disease, diabetes, dry eyes, thyroid problems, or other health problems should tell their doctors beforehand, as the blepharoplasty procedure could exacerbate these problems.

A great video About Your Blepharoplasty

What are the benefits of blepharoplasty?

Because the procedure itself is relatively short-usually lasting between one and three hours and minimally invasive patients are put under a local anesthetic and never go completely under-blepharoplasty is commonly seen as relatively quick and easy fix to a problem that affects millions of adults.

Aside from the obvious benefits of improving the overall appearance of the eyes, those who have undergone eyelid surgery say the procedure has changed the way they feel about themselves and improved self-esteem and confidence issues.

For those undergoing surgery because of medical concerns, eyelid surgery can greatly improve a patient’s vision and restore the peripheral vision that was obscured by sagging eyelids.

What risks are involved?

Risks of an eyelid surgery may include irritated eyes, blurred vision, temporary numbness of the eyelid skin, and difficulty closing eyes while sleeping, swelling, scarring, tiny whiteheads after stitches are removed, and infection from the local anesthesia used in the procedure. Although rare, eyelid surgery patients should also be aware that there is a very small risk of blindness due to bleeding behind the eye. For many patients, scars may remain pink for six or more months after surgery, although these scars eventually fade with time into a nearly invisible white line.

Despite the bevy of risks, eyelid surgery is known as a relatively safe and effective procedure when performed by a licensed medical professional. If you go to http://blepharoplastytoronto.ca/ you can get more information about this procedure and even find some information about consultation if you’re in the Toronto area. Check with your local doctor whatever city you may be located in to get a recommendation.

All patients should consult with their doctor about potential risks and side effects before undergoing surgery, and may need to weight the risks and benefits when deciding whether eyelid surgery is the right option.

The thyroid gland sits in the middle of the neck atop the windpipe. The butterfly shaped gland has two lobes: a left lobe and a right lobe. The thyroid gland makes and secretes thyroid hormone. Thyroid hormone is involved in maintaining the body’s metabolism.The most common reason patients are referred for thyroid surgery is after evaluation for a thyroid nodule. Thyroid nodules are fairly common particularly in women. Because nodules are so common, further evaluation is warranted only after the nodule reaches a certain size, 1cm. A fine needle aspiration, which is performed in the office under local anesthesia, is the first step in diagnosis. A needle and syringe is inserted through the skin into the nodule to extract some cells for analysis. If the biopsy results come back as cancer or possible cancer, then thyroid surgery will be recommended.Surgery may also be recommended for a goiter, which is essentially an enlarged thyroid. A goiter is benign but, if large enough, can cause symptoms such as difficulty swallowing or pain and pressure in the neck.

Women – women are three times as likely as men to develop thyroid cancer

Race- Caucasians are more likely to get thyroid cancer than African-Americans

Family history of thyroid cancer

History of radiation exposure to the neck

Iodine deficiency in the diet

How is it diagnosed?

The diagnosis of cancer or possible cancer is made with a thyroid biopsy. Thyroid biopsies can be done in the office. A small needle and syringe is inserted into the nodule and a few cells are aspirated. Those cells are examined under a microscope to make the diagnosis. If the results return as cancer or possible cancer, then surgery is scheduled.

How do I prepare for surgery?

If you are over 45 years old, you will need some additional preoperative testing to aid the anesthesiologist in taking care of you. Those tests include blood work, a chest X-ray, and an EKG.

How is the surgery performed?

A horizontal incision is made along the base of your neck usually along a skin crease. The thyroid gland is identified, carefully detached from the windpipe, and removed, with care taken not to destroy adjacent structures.

For a diagnosis of cancer, atotalthyroidectomy, removal of the entire gland, is performed to remove any cancer cells that my have spread within the thyroid gland. Complete treatment of thyroid cancer includes administration of one dose of radioactive iodine to kill any remaining thyroid cells that may have spread beyond the thyroid.

For a diagnosis of possible cancer, only the lobe where the cancer is suspected is removed. This is a called athyroid lobectomy. If after removal of the one lobe, the diagnosis of cancer is confirmed, then a second surgery is needed to remove the remaining thyroid.

For patients with hyperthyroidism, many surgeons recommend asubtotal thyroidectomy. This involves removing one lobe in its entirety and then a subtotal or near total resection of the opposite lobe. The small tuft of thyroid remaining may prevent the need for lifelong thyroid hormone supplementation.

Complications of Surgery

The most serious risks of thyroid surgery include bleeding underneath the skin resulting in a blood clot that puts pressures on other structures such as the windpipe. Pressure on the windpipe can cause difficulty breathing.

Two key structures exist in the neck close to the thyroid and can be damaged during surgery. The recurrent laryngeal nerve lies along the back of the thyroid. This nerve is responsible for movement of the vocal cords. Injury to the nerve can cause voice hoarseness which is most often temporary but can be permanent. The other structures are the parathyroid glands which control calcium levels in the body. They often get bruised during surgery, causing low calcium levels in your blood and requiring you to take calcium supplements temporarily. If they are permanently damaged, you will need to take calcium supplements for life.

The last two complications mentioned are rare in the hands of experienced surgeons. Patients at higher risk for these complications are those with large goiters extending below the collar bone or in those undergoing their second operation on the thyroid.

What to expect after surgery?

The surgery usually takes approximately 2 hours. There may be a surgical drain placed next to the incision in your neck. This will be removed the morning after surgery. Your throat may be sore because of the breathing tube placed during the operation. You will be able to drink liquids immediately after surgery and eat once you are fully awake. You will be discharged the day after surgery. Those who have had a thyroidectomy will be hypothyroid (exhibiting underactive thyroid function) after surgery and will need to take a daily thyroid hormone pill. If you had a diagnosis of cancer, you will need to see an endocrinologist to schedule the administration of the radioactive iodine. Those who have a thyroid lobectomy will not need any supplemental medication

The trachea, or windpipe as it is known colloquially, is a circular tube that allows air you breathe to enter into your lungs. The trachea starts at your voice box in the upper part of the neck down into the chest. The trachea is a circular tube made up of 16-20 rings of cartilage. A tracheostomy is a surgically created opening into the trachea. A tracheostomy tube is inserted into that hole and allows a direct passage of air from the environment or from a breathing machine called a ventilator, into the lungs.Who is at risk? A tracheostomy may be performed to fix a variety of problems including

Decreased air flow into the lungs caused by an inherited abnormality of the larynx or trachea

Compression of the trachea caused by swelling or bleeding brought on by severe neck or mouth injuries

Damage to the trachea caused by breathing corrosive material, smoke, or steam

A large object blocking the trachea, such as a tumor

Excess secretions and mucous building up in the airway, of which a tracheostomy is used to facilitate clearance

Paralysis of the muscles that affect swallowing

Long-term unconsciousness or coma.

Patients who need prolonged breathing support from a ventilator (longer than 2 weeks) will often have this procedure performed. A tracheostomy in the neck is preferable to a breathing tube inserted through the mouth because it is often more comfortable for the patient. It can also be safer as the breathing tube through the mouth can cause damage to the trachea resulting in narrowing, if placed for longer than 2 weeks. Finally, it is easier to “wean” the patient off the ventilator with a tracheostomy tube than with a breathing tube. Patients can be disconnected from the ventilator and breathe on their own through a tracheostomy tube. These breathing trials – or trach collar trials, as they are often called – are often done as “mock” trials to see how well someone can breathe on their own without the help of a ventilator. Trach collar trials can be performed for a few hours at a time. In between trials, the tracheostomy tube is reconnected to the ventilator to provide the patient with a period of rest. How is the surgery performed? A small horizontal or vertical 1 inch incision is made into the neck below the Adam’s apple but above the breastbone. The neck muscles are parted and the trachea is identified. An incision is made between the tracheal rings. The tracheostomy tube is inserted through this hole between the rings down to the trachea. A supply of oxygen can be attached to the tube to increase the flow of oxygen to the lungs. The tracheostomy tube can also be attached to a ventilator if the patient is unable to breathe on his or her own.Complications from Surgery? This is a commonly performed and safe procedure. Risks include damage to the voice box or esophagus during the procedure or a collapsed lung. These complications tend to occur early after surgery but are very rare. Complications that tend to occur months to years after tracheostomy surgery include erosion of the tracheostomy tube into a nearby artery or to the esophagus. These complications require an operation to be fixed. Tracheostomy tubes require regular maintenance cleaning or else they can get clogged with mucous or other secretions. What to expect after surgery?

It takes some time to adapt to breathing through a tracheostomy tube. With training and practice, most patients can learn to talk with a tracheostomy tube in place. However, when on the ventilator, a person is unable to talk.

Between 4 and 10 days after surgery, the initial tracheostomy tube will be changed to a smaller tube. Tracheostomies can be temporary or permanent. If temporary, the tracheostomy tube will be downsized to a smaller tube usually in at least two different changes. Once the tracheostomy tube is removed, a dressing is placed over the hole. The hole generally seals up on its own within a few days. In rare cases, the hole does not close and a second operation is required to close the it. If the tracheostomy is meant to be permanent, home care instructions will be given prior to discharge from the hospital. Regular cleaning of the tracheostomy is required to clean the secretions that might build up.

Anatomy and physiology – what is the carotid artery and what does it do?
The common carotid artery carries blood from the heart to the brain. The main blood vessel exiting the heart is called the aorta. The common carotid artery is a branch off of the aorta and travels up the neck. Halfway up the neck, the common carotid branches into the internal and external carotid arteries. The internal carotid artery is the branch that eventually supplies the brain with oxygen-filled blood. There is a left and right carotid artery.
Atherosclerosis is a disease that describes the formation of plaque on blood vessels. Plaque is composed of cholesterol, calcium, and fibrous tissue. When it settles on the wall of the artery, the artery stiffens and narrows. Carotid stenosis is the term used to describe the narrowing of the carotid artery. As the stenosis progresses, blood flow to the brain becomes compromised. Carotid stenosis can lead to stroke and mini-strokes, also called transient ischemic attacks (TIA’s) in two ways, by narrowing the artery as described above or via an embolus. An embolus is a piece of plaque that was flicked off by the main plaque or a piece of clot that settled on the plaque and then migrated. The embolus gets carried away by the circulation of blood and eventually lodges into a smaller blood vessel in the brain, denying oxygen to a part of the brain and causing the stroke.
Many surgeons will recommend surgery to remove the plaque in the carotid artery when you have been found to have significantly advanced carotid stenosis putting you in danger of having a stroke or TIA.
Who is at risk?
Atherosclerosis has been linked directly to smoking and high cholesterol. In addition, diabetes and obesity are also associated with a high risk of developing atherosclerosis.How is it diagnosed?

Carotid stenosis can sometimes be detected by physical exam. When your physician holds the stethoscope against your neck, they may hear a “bruit” or sounds of turbulence in your artery. The diagnosis can be confirmed with an ultrasound of the blood vessels. If the results of the ultrasound are not conclusive a CT scan, MRA (magnetic resonance arteriography) or an arteriogram may be recommended by your physician.

How do I prepare for surgery?

Blood samples will be needed as well, as an EKG and chest X-ray. Depending on your health and medical history, your doctor may recommend a cardiac stress test to determine if your heart can withstand the stress of an operation. If you have lung disease, your doctor may also suggest tests of pulmonary function to help the anesthesiologist manage your lungs while you are under general anesthesia.

How is the surgery performed?

The surgery is usually performed under general anesthesia. Some surgeons do perform “awake” carotid endarterectomies if you have other medical problems that put you at high risk for surgery and general anesthesia. During an awake procedure, your surgeon will limit the amount of pain you feel by infusing local anesthesia under the skin. The benefit of having you awake during surgery is that your surgeon can check on you from time to time to make sure you are not experiencing an adverse reaction from having your artery clamped.

An incision will be made along your neck from the angle of the jaw down to the base of the neck. A clamp will be placed on the carotid artery temporarily preventing blood flow to your brain. Your brain will receive blood flow from the carotid artery on the opposite side where your surgeon is working. Then, the carotid artery will be opened. The plaque will be removed. The cut in the artery will then be sewn with a patch.

Carotid endarterectomy with patch

Potential Complications of Surgery

Most patients tolerate the surgery fairly well. Factors that increase your risk of developing a complication include high blood pressure that is not well managed, blockages in the carotid artery on the opposite side of where you are having surgery, and any history of a recent heart attack.

The earliest complication that could occur is bleeding under the skin that causes a blood clot. If you experience a significant amount of bleeding, the blood under the skin can push aside other structures in the neck, such as your windpipe. This would require an immediate trip back to the operating room to drain the blood. Another serious complication is that of a stroke. The risk is very low ranging between 1 and 3 percent.

Finally, re-blockage of the artery is another uncommon but possible complication, particularly if you have not modified any of the risk factors of atherosclerosis, such as smoking and a high fat diet. This complication if it occurs happens months to years after surgery.

What to expect after surgery?

You will be admitted on the day of surgery and watched closely overnight for any signs of bleeding or a stroke. Some surgeons will leave a temporary drain in your neck to catch any bleeding that might occur. This drain will be removed in the morning. Generally, patients are discharged the day after surgery.

This section of surgeryinfo.org deals with surgeries of the head and neck. The neck in particular contains a number of vital structures including the carotid arteries, the trachea (the windpipe), and the thyroid gland. Surgery on the head and neck is performed by neurosurgeons, ear, nose and throat surgeons (otolaryngologist), vascular surgeons, thoracic surgeons, and general surgeons depending on the organ involved.